Claims Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Resolve medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner • Investigate claims and communicate with others to obtain necessary information • Enter data into the claims system • Review and interpret contract benefits • Conduct edit and audit resolution • Determine benefit eligibility • Identify and research processing issues using systems and manuals • Route claims to other areas • Consult internal staff and medical providers • Generate correspondence • Complete forms to obtain necessary information • Complete initial training, on-the-job training, and continuing education • Stay current with changing processing procedures, benefits, and system modifications • Meet corporate and national (MTM) standards for productivity and quality • Use corporate and professional manuals and guidebooks, including processing manual and ICD, CPT, and HCPS codebooks • Perform other duties as assigned

🎯 Requirements

• High School diploma or equivalent • Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field, OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office • Must pass company proficiency test: Claims Assessment • Oral & Written Communications • Strong Interpersonal skills • Sound Judgement • Decision Making • Detail-Oriented • Teamwork • Dependability • Must ensure the security and confidentiality of records and information • Must adhere to segregation of duties guidelines in the Administrative Manual

🏖️ Benefits

• Initial training, on-the-job training, and continuing education • Access to relevant computer systems and screens • Regular employment